title: The management of iron deficiency in inflammatory bowel disease--an online tool developed by the RAND/UCLA appropriateness method.
abstract: BACKGROUND
  Iron deficiency is a common and undertreated problem in inflammatory bowel disease (IBD).
  
  
  OBJECTIVE
  To develop an online tool to support treatment choice at the patient-specific level.
  
  
  METHODS
  Using the RAND/UCLA Appropriateness Method (RUAM), a European expert panel assessed the appropriateness of treatment regimens for a variety of clinical scenarios in patients with non-anaemic iron deficiency (NAID) and iron deficiency anaemia (IDA). Treatment options included adjustment of IBD medication only, oral iron supplementation, high-/low-dose intravenous (IV) regimens, IV iron plus erythropoietin-stimulating agent (ESA), and blood transfusion. The panel process consisted of two individual rating rounds (1148 treatment indications; 9-point scale) and three plenary discussion meetings.
  
  
  RESULTS
  The panel reached agreement on 71% of treatment indications. 'No treatment' was never considered appropriate, and repeat treatment after previous failure was generally discouraged. For 98% of scenarios, at least one treatment was appropriate. Adjustment of IBD medication was deemed appropriate in all patients with active disease. Use of oral iron was mainly considered an option in NAID and mildly anaemic patients without disease activity. IV regimens were often judged appropriate, with high-dose IV iron being the preferred option in 77% of IDA scenarios. Blood transfusion and IV+ESA were indicated in exceptional cases only.
  
  
  CONCLUSIONS
  The RUAM revealed high agreement amongst experts on the management of iron deficiency in patients with IBD. High-dose IV iron was more often considered appropriate than other options. To facilitate dissemination of the recommendations, panel outcomes were embedded in an online tool, accessible via http://ferroscope.com/.
authors.affiliation: Department Internal Medicine III, Medical University of Vienna, Vienna, Austria.
authors.forename: W
authors.initials: W
authors.lastname: Reinisch
authors.forename: Y
authors.initials: Y
authors.lastname: Chowers
authors.forename: S
authors.initials: S
authors.lastname: Danese
authors.forename: A
authors.initials: A
authors.lastname: Dignass
authors.forename: F
authors.initials: F
authors.lastname: Gomollón
authors.forename: O Haagen
authors.initials: OH
authors.lastname: Nielsen
authors.forename: P L
authors.initials: PL
authors.lastname: Lakatos
authors.forename: C W
authors.initials: CW
authors.lastname: Lees
authors.forename: S
authors.initials: S
authors.lastname: Lindgren
authors.forename: M
authors.initials: M
authors.lastname: Lukas
authors.forename: G J
authors.initials: GJ
authors.lastname: Mantzaris
authors.forename: P
authors.initials: P
authors.lastname: Michetti
authors.forename: B
authors.initials: B
authors.lastname: Moum
authors.forename: L
authors.initials: L
authors.lastname: Peyrin-Biroulet
authors.forename: M
authors.initials: M
authors.lastname: Toruner
authors.forename: J
authors.initials: J
authors.lastname: van der Woude
authors.forename: G
authors.initials: G
authors.lastname: Weiss
authors.forename: H
authors.initials: H
authors.lastname: Stoevelaar
mesh_terms: D061605:Administration, Intravenous; D018798:Anemia, Iron-Deficiency / Q000209:etiology* / Q000628:therapy; D001803:Blood Transfusion / Q000379:methods; D020000:Decision Support Systems, Clinical; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D006397:Hematinics / Q000627:therapeutic use; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000188:drug therapy; D020407:Internet; D007501:Iron / Q000008:administration & dosage; D000090463:Iron Deficiencies; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data
chemical_list: D006397:Hematinics; D007501:Iron